Abstract Communication of clinically important follow-up recommendations when abnormalities are identified on imaging studies is prone to error. The absence of an automated system to identify and track radiology follow-up recommendations is an important barrier to ensuring timely follow-up of patients, especially for non-acute but potentially life threatening and unexpected findings. The primary goal of this proposal is to develop a Natural Language Processing (NLP) system to extract clinically important recommendation information from free-text radiology reports. Each radiology report will be preprocessed at the structural, syntactic, and semantic level to generate features that will be used to extract the boundaries of sentences that include recommendation information as well as the details of reason for recommendation, requested imaging test, and recommendation time frame. We will use a large corpus of free-text radiology reports represented by a mixture of modalities (e.g., radiography, computed tomography, ultrasound, and magnetic resonance imaging (MRI)) from three different institutions. Using this dataset we will perform the following specific aims: Aim 1. Create a multi- institutional radiology report corpus annotated for clinically important recommendation information; Aim 2. Develop a novel NLP system to extract clinically important recommendations in radiology reports. The proposed research is innovative because it will generate a new text processing approach that can be used to flag reports visually and electronically so that separate workflow processes can be initiated to reduce the chance that necessary investigations or interventions suggested in the report are missed by clinicians. The proposed set of tools will be disseminated to the biomedical informatics community as open source tools.